When Debra Tansey lost her management job last year, her insurance disappeared with it.
The Chesapeake woman did what a lot of people in her position do: "I started backing off my medications."
First she tried reducing the dosage to make the pills last longer. Then she stopped taking some entirely -- a prescription for an ulcer, an antidepressant, and a couple of pain relievers for chronic shoulder pain.
Tansey, 51, may not be doing what the doctor ordered, but it's a step many people have felt forced into during the recession.
A Kaiser Family Foundation survey conducted late in 2008 found that 27 percent of people had decided not to fill a prescription during the past year. About one-third said they had problems paying medical bills, compared with one-fourth in 2006, and almost half said a family member delayed or cut back on health care because of cost.
Luckily, Tansey held sacred her blood-pressure medication. "I didn't want to roll over and die." When she needed the prescription renewed, however, she couldn't afford to go to the doctor. A friend told her about Chesapeake Care, a free clinic for people who don't have health insurance.
She qualified for care there in October and was able to see a doctor and get back on her prescriptions. Like free clinics across the state, Chesapeake Care has seen a dramatic increase in people seeking care, which means more people needing prescription drugs.
Cathy Lewis, executive director of the clinic, said the number of prescriptions filled in December 2008 was 15 percent higher than in December 2007.
The clinic helps people get their drugs through The Pharmacy Connection, a software program created by the Virginia Health Care Foundation to link people with free medications.
Deborah Oswalt, executive director of the foundation, said a tally of 43 agencies across the state that use the computer program showed that requests for prescriptions during the past six months rose by 1,540 over the six-month period before that, for an increase of $7.4 million worth of drugs.
Oswalt said organizations are asking for more funding for caseworkers to help process the requests.
"For every person who finds help, there are 10 or more who aren't and they're trying to nurse things along," she said.
The Partnership for Prescription Assistance, which includes more than 475 programs sponsored by pharmaceutical companies and other groups, reported 10,000 more requests for help in Virginia during the first three months of this year compared with the first three months of last year -- a 44 percent increase.
That was much larger than the national increase of about 10 percent, said Ken Johnson, spokesman for the effort and senior vice president of the Pharmaceutical Research and Manufacturers of America.
He said the partnership is adding more phone operators to handle calls and some pharmaceutical companies are relaxing their requirements for eligibility.
Tansey lost her job in January 2008 and tried to get some routine medical work done, such as a dental checkup and an annual Pap smear test for cervical cancer, before she lost her insurance.
As the divorced mother went off her medications, it was harder to sleep because of the pain in her shoulder. She started walking in a nearby park for exercise, which helped. She leaned on her brother for moral support and her church, New Faith Christian Fellowship in Virginia Beach, to lift her spirits.
She lowered the temperature in her house during the cold months and tried to find ways to reduce her food bill. Once she started going to Chesapeake Care, she found out about a smoking-cessation class.
She knew cigarettes were working against her health and her pocketbook, so she signed up.
"There are so many things in my life I can't control, like keeping my job," Tansey said. "I needed to feel empowered."
She quit smoking on Feb. 5. She recently started working at Norfolk Naval Shipyard doing payroll and time card keeping, so she feels optimistic about both her health and her future.
Lewis, of Chesapeake Care, said the clinic has signed on new patients who have gone for months without their medications.
"Sometimes you don't feel bad when you stop," she said, "and if you feel OK, you think you're OK until you end up in the emergency room."
It's not just the uninsured who have trouble paying for drugs.
Ann Okeefe, who helps people with medication assistance at Senior Services of Southeastern Virginia, said people with Medicare Part D coverage for drugs still struggle with costs. Many have had to pay higher monthly premiums, and some are on newer medications that cost more and don't have generic alternatives.
Many are falling into the "doughnut hole," in which there's a gap in coverage, earlier than they did in previous years. Some seniors will skip doses to keep from falling into that gap.
Algar Lee, a 71-year-old Virginia Beach woman, qualifies for Medicare, the federal insurance for people 65 and older, and said she used to be able to afford the co-payments for her drugs using her income as a nurse's aide.
In September, though, she got sick with an infected cyst in her stomach and had to go to the hospital. Since then she's been unable to work and has struggled to afford her rent, utilities, food and co-payments on her drugs.
She was able to get some help from The Patient Advocate Foundation, a nonprofit organization that helps people maintain access to health care, and from some families of her former clients. Still, she's anxious to get back to work.
"My doctor said I shouldn't be working at 71, but I can't live from month to month on donations."
Elizabeth Simpson, (757) 446-2635, elizabeth.simpson@pilotonline.com To see more of the The Virginian-Pilot, or to subscribe to the newspaper, go to http://www.pilotonline.com. Copyright (c) 2009, The Virginian-Pilot, Norfolk, Va. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
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